Catatonia in N-methyl-d-aspartate receptor antibody encephalitis: Phenomenological characteristics from a systematic review of case reports

Serra-Mestres, Jordi; Villagrasa, Beatriz; Thacker, Vikram; Jaimes-Albornoz, Walter; Sharma, Priyamvada; Isetta, Marco

doi:10.1016/j.genhosppsych.2020.01.002

Cited by 9 publications

(8 citation statements)

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“…The spectrum of clinical features of catatonia in anti-NMDAR encephalitis still needs to be explored. A review including 189 patients showed that the most frequent signs were immobility/stupor, mutism, excitement, posturing/catalepsy, stereotypy and rigidity [ 13 ]. In another review involving 30 cases, excitement, immobility/stupor, mutism, withdrawal, posturing, rigidity, stereotypy and perseveration were successively the most common catatonic symptoms [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the lack of consistent operational definitions and systematic division of psychopathology may also make the discrepancy. The stuporous type and the excited type are two classic types of catatonia [ 13 ]; however, approximately 33 to 56.1% of catatonic patients with anti-NMDAR encephalitis presented with fluctuations between stuporous and excited symptoms [ 12 , 13 , 40 ]. The fluctuating type was found in a large proportion of patients in our cohort (32.0%), replicating this unique phenomenon in catatonia with anti-NMDAR encephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…Espinola-Nadurille et al reported catatonia with more delirium, hallucinations and psychomotor agitation during hospitalization [ 12 ]. Serra-Mestres et al reported that catatonia was frequently combined with dysfunctions of psychosis, mood (anxiety, elation, or depression) and cognition [ 13 ]. In our study, we found that symptoms tended to occur together with signs such as aggression, mood disorder and decreased consciousness.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review of all cases of catatonia in autoimmune diseases, anti-NMDAR encephalitis accounted for 72% of cases [11]. Although this proportion is large, only a few studies have focused on the description of catatonic syndrome in anti-NMDAR encephalitis [12][13][14]. In addition, autoimmune disease-related catatonia was found to be associated with other severe psychiatric features and more relapses in children [15].…”

Section: Introductionmentioning

confidence: 99%

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Catatonia in adult anti-NMDAR encephalitis: an observational cohort study

Zhou

et al. 2023

BMC Psychiatry

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Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most prevalent autoimmune encephalitis and is closely related to catatonia. This study aimed to investigate the clinical features and disease outcomes of adult catatonic anti-NMDAR encephalitis patients. Methods Adult patients diagnosed with anti-NMDAR encephalitis between January 2013 and October 2021 were retrospectively enrolled in this study. According to the Bush Francis Catatonia screening instrument (BFCSI), patients were divided into two groups: those with catatonia and those without catatonia. The modified Rankin scale (mRS), Clinical Assessment Scale for Autoimmune Encephalitis (CASE), Neuropsychiatric Inventory (NPI), Patient Health Questionnaire-9 (PHQ-9) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores were assessed at follow-up. The Mann–Whitney U test (nonparametric), Student’s t test (parametric), and chi-squared test were used to analyse the differences between the two groups. Results Eighty-four patients were recruited, including twenty-five catatonic patients and fifty-nine noncatatonic patients. Among them, 28 had positive antibody only in cerebrospinal fluid (CSF), 4 had positive antibody only in serum and 52 had positive antibody both in CSF and serum. Catatonic patients experienced more disturbance of consciousness (p = 0.01), aggression (p = 0.046) and affective disorders (p = 0.043) than noncatatonic patients. The mRS scores of the catatonia group assessed at admission (p = 0.045) were worse than those of the non-catatonia group. Catatonic patients were more inclined to develop deep vein thrombosis (p = 0.003), decubitus (p = 0.046), pneumonia (p = 0.025), and to be admitted to the intensive care unit (ICU) (p = 0.011) than noncatatonic patients. All patients in the catatonia group received first-line immunotherapy. At the 24-month follow-up, 2 patients in the catatonia group did not achieve good outcomes. At the last follow-up, the catatonia group had more relapses (p = 0.014) and more neuropsychiatric problems (p = 0.035). Conclusions Adult anti-NMDAR encephalitis patients with catatonia present distinct clinical features in disease course and are prone to experience more relapses and long-term neuropsychiatric problems than those without catatonia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Catatonia in adult anti-NMDAR encephalitis: an observational cohort study

Zhou

et al. 2023

BMC Psychiatry

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“…Between 0.6 and 1.7% of children and adolescents who are hospitalized for mental health pathologies have diagnosis of catatonia ( 6 ). It can occur in up to 37% of persons with NMDA receptor antibody encephalitis ( 7 ) and in 17% of patients with autistic spectrum disorders ( 8 ). Depending on the diagnostic criteria used, the frequency of catatonia in hospitalized psychiatric patients over the age of 65 ranges from 39.6 to 17.9% ( 9 ).…”

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confidence: 99%

Editorial: Catatonia across the lifespan

Cuevas‐Esteban

Serra-Mestres²,

Grover

et al. 2022

Front. Psychiatry

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the Research Topic Catatonia across the lifespan A neuropsychiatric syndrome called Catatonia comprises motor, emotional, behavioral, and autonomic abnormalities. It is hence a psychomotor syndrome as it does not only affect motility. Therefore, it can be distinguished from other pure motor disorders such as extrapyramidal syndromes (1). Since the initial description of catatonia by Kahlbaum in 1874, it has also been connected to affective and medical conditions (2). The DSM-5 enhances diagnostic standards and the capacity to identify catatonia in the setting of any mental or medical condition (3).Despite having a prominent clinical presentation and being a prevalent condition, catatonia is, nevertheless, underdiagnosed and undertreated. Its mean prevalence, regardless of the underlying condition, was 9.2% (4). Medical conditions have a higher prevalence rate (20.6%), followed by bipolar disorder (20.2%), postpartum psychosis (20%), autism (11.1%), schizophrenia (9.8%), and mixed psychiatric conditions (5.5%) (4).Catatonia can occur at any stage in life linked to a wide range of physical and mental health conditions, having specific characteristics in children and in older adults (5). Between 0.6 and 1.7% of children and adolescents who are hospitalized for mental health pathologies have diagnosis of catatonia (6). It can occur in up to 37% of persons with NMDA receptor antibody encephalitis (7) and in 17% of patients with autistic spectrum disorders (8). Depending on the diagnostic criteria used, the frequency of catatonia in hospitalized psychiatric patients over the age of 65 ranges from 39.6 to 17.9% (9). In aged individuals, co-morbidity and neurodegeneration increase the likelihood of catatonic symptoms.

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